Age-related Changes In Vision Research Articles

The use of driver screening tools to predict self-reported crashes and incidents in older drivers

There is a clear need to identify older drivers at increased crash risk, without additional burden on the individual or licensing system. Brief off-road screening tools have been used to identify unsafe drivers and drivers at risk of losing their license. The aim of the current study was to evaluate and compare driver screening tools in predicting prospective self-reported crashes and incidents over 24 months in drivers aged 60 years and older. 525 drivers aged 63–96 years participated in the prospective Driving Aging Safety and Health (DASH) study, completing an on-road driving assessment and seven off-road screening tools (Multi-D battery, Useful Field of View, 14-Item Road Law, Drive Safe, Drive Safe Intersection, Maze Test, Hazard Perception Test (HPT)), along with monthly self-report diaries on crashes and incidents over a 24-month period. Over the 24 months, 22% of older drivers reported at least one crash, while 42% reported at least one significant incident (e.g., near miss). As expected, passing the on-road driving assessment was associated with a 55% [IRR 0.45, 95% CI 0.29–0.71] reduction in self-reported crashes adjusting for exposure (crash rate), but was not associated with reduced rate of a significant incident. For the off-road screening tools, poorer performance on the Multi-D test battery was associated with a 22% [IRR 1.22, 95% CI 1.08–1.37] increase in crash rate over 24 months. Meanwhile, all other off-road screening tools were not predictive of rates of crashes or incidents reported prospectively. The finding that only the Multi-D battery was predictive of increased crash rate, highlights the importance of accounting for age-related changes in vision, sensorimotor skills and cognition, as well as driving exposure, in older drivers when using off-road screening tools to assess future crash risk.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study.

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits. The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education). Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained. Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.

Impact of Age-Related Vision Changes on Driving.

Aging leads to impaired visual function, which can affect driving—a very visually demanding task—and has a direct impact on an individual’s quality of life if their license is withdrawn. This study examined the associations between age-related vision changes and simulated driving performance. To this end, we attempted to determine the most significant visual parameters in terms of evaluating elderly drivers’ eyesight. Twenty-one younger drivers (aged 25–40) were compared to 21 older drivers (aged 56–71). Study participants were assessed for visual acuity, contrast sensitivity, halos, and intraocular straylight, which causes veiling luminance on the retina and degrades vision. Driving performance was evaluated using a driving simulator. The relationships between simulated driving performance and the visual parameters tested were examined with correlation analyses and linear regression models. Older drivers presented impairment in most visual parameters (p < 0.05), with straylight being the most significantly affected (we also measured the associated effect size). Older drivers performed significantly worse (p < 0.05) in the simulator test, with a markedly lower performance in lane stability. The results of the multiple linear regression model evidenced that intraocular straylight is the best visual parameter for predicting simulated driving performance (R2 = 0.513). Older drivers have shown significantly poorer results in several aspects of visual function, as well as difficulties in driving simulator performance. Our results suggest that the non-standardized straylight evaluation could be significant in driver assessments, especially at the onset of age-related vision changes.

Visual Performance and Occupational Safety Among Aging Workers.

With the rapid growth of the aging workforce, age-related conditions may negatively influence overall workplace safety and health among these workers and their employers. In this summary, we have outlined details about visual acuity, glare sensitivity, and contrast sensitivity, which are common age-related vision changes that can potentially affect their occupational safety. The occupational health nurse is well positioned to address these concerns by instructing aging workers about potential development of vision change and ensuring they receive the appropriate vision screening. By assisting employers to modify work environments to accommodate this population, the occupational health nurse can reduce the risk of injury, as well as positively impact the health of their aging workforce.

Death (and Taxes) May be Certain. is Vision Loss?

Vision provides critical sensory input for many tasks that affect functional performance and quality of life. Although other senses and compensatory techniques can provide input for many of these tasks, it is vision that is central to knowledge of the environment. Consequently, the impact of any loss of vision cannot be overstated. Even the earliest stages of vision loss harbinger significant changes in everyday activities such as reading or driving, vocational choice, or avocational activities and may also affect self-esteem and independence (Morse, 2012, p. 235). Vision loss in the United States, including low vision and blindness, affects approximately 1 in 28 Americans who are older than 40 years of age. Although the cause-specific rates of vision loss vary for each cause by race, ethnicity, gender, and other personal characteristics, the overall prevalence of vision loss increases with aging. The probability of vision loss increases with age among all population segments, especially those older than 60 years (Morse, 2012), and among the oldest segment of our population, those over age 85, the prevalence of vision loss is rising most rapidly (Varma et al., 2016), underscoring the relationship between vision and aging. IMPORTANCE OF PREVENTION, IDENTIFICATION, AND TREATMENT Significantly, each of the four leading causes of blindness--cataracts, glaucoma, macular degeneration, and diabetic retinopathy--are not uniformly susceptible to treatment or vision restoration procedures. As a result, it is important to understand the differential potential for prevention, identification, and treatment of these and other eye disorders to minimize their deleterious effects. All providers of healthcare services should be engaged in this effort. Regardless of etiology, however, early identification will always yield the best result with the least impact on quality of life. It is also important to differentiate between age-related vision changes that are unavoidable from pathology that can be identified and addressed: Although both may result vision loss, pathology often can be addressed, but aging obviously cannot. For example, the lens of the eye yellows with aging, which causes distortion of color vision, but yellowing alone does not affect vision. The ultimate goal is not merely the promotion of eye health, but the actual improvement of eye health. The behavioral aspects and other barriers to adherence with eye health guidelines need careful attention. In addition, the causes of medication nonadherence, for example, as well as other issues need further study so that they may be effectively addressed. Each of the leading causes of vision loss has differential effects on the population--some groups are more at risk and suffer more loss of vision than others. Issues of disparity and cultural sensitivity are generally overlooked but adversely affect millions of Americans each year. Readers of this journal most often focus on helping people after they have lost vision, and this perspective needs to be changed. Prevention is better than cure; in many cases there is no cure, and vision loss is irreversible. Consequently, more attention needs to be paid to early identification and timely intervention to reduce preventable vision loss and, in other cases, reduce the severity of vision loss. Across the United States, there are hundreds of organizations whose mission is to help people with vision loss, but few of them contemplate prevention and virtually none consider surveillance. One reason for this disconnect is a mismatch between the needs of the population and the availability of government funding. The vast majority of federal and state funds are directed at vocational rehabilitation, while the vast majority of Americans who are at risk for or who are currently experiencing vision loss are on the upper edge of the workforce in terms of age or have already ceased working. There are also state-determined levels of vision that must be met for eligibility for services: some states require legal blindness while others accept vision loss or low vision as the threshold. …

Characteristics of United States Emergency Department Visits for Traumatic Amputations in the Elderly Adult from 2010 to 2013.

Elderly adults (65years of age and older) are of particular concern for traumatic amputations due to age-related changes in vision and coordination, making them more susceptible to injury. The objective of this study is to describe the epidemiology of traumatic amputations in the elderly adults treated in United States emergency departments (ED). A retrospective analysis using data from the National Electronic Injury Surveillance System from 2010 to 2013. People aged 65years and older treated in U.S. hospital EDs for traumatic amputations from 2010 to 2013. There were 15,611 elderly patients treated for amputations from 2010 to 2013, averaging 3,902 amputations per year in the United States. The frequency of amputations declined with increasing age. The mean age was 74years old. Males represented 84% of the cohort. The majority of the injuries that were recorded took place at home (71%). The most common associated consumer products were saws, lawnmowers, and doors. Saws accounted for approximately 45% of amputations. In females, doors were the most common consumer product associated with amputations. Approximately 45% of amputations were complete amputations. The most common digit to be amputated was the thumb (24%). Approximately 72% of the cases in the cohort were treated and released from the ED. Traumatic amputations in elderly adults were frequently due to saws and lawnmowers. An increase in injury prevention efforts in this patient population is warranted.

Positive display polarity is advantageous for both younger and older adults

The effect of display polarity on visual acuity and proofreading performance was investigated for younger and older adults. An advantage of positive polarity (dark characters on light background) over negative polarity (light characters on dark background) was expected for younger adults, but the effects on older adults were ambiguous. Light scatter due to residues in the senescent lens and vitreous humour could reverse the typical advantage of positive polarity. However, age-related changes lead to a decline in retinal illuminance. Brighter positive polarity displays should help to compensate for this decline and, accordingly, lead to better performance than darker negative polarity displays. Participants conducted a visual acuity test with black optotypes on white background or white optotypes on black background and performed a proofreading task in the same polarity. A positive polarity advantage was found for both age groups. The presentation in positive polarity is recommended for all ages. Practitioner summary: In an ageing society, age-related vision changes need to be considered when designing digital displays. Visual acuity testing and a proofreading task revealed a positive polarity advantage for younger and older adults. Dark characters on light background lead to better legibility and are strongly recommended independent of observer's age.

Age-related Changes in Vision and Required Illumination for the Elderly(&lt;Special Issue&gt;Learning from the Great East Japan Earthquake : Lighting for the Elderly and People with Low Vision)

We calculated equivalent illuminance levels and their ratios for young and elderly people by combining data on age-related changes of human crystalline lens and pupil size. The results reveal that effective illuminance for the elderly is a quarter of that for young people when, for energy savings, environmental illuminance is reduced to half. In addition, visibility of the elderly is lower than that of the young even though equivalent illuminance is ensured for the elderly. Finally, we showed that some considerations, such as more than doubling the illuminance of the young, may be necessary for the elderly when energy savings are conducted in public spaces.

Age and disease-related structural changes in the retinal pigment epithelium.

As the retinal pigment epithelium (RPE) ages, a number of structural changes occur, including loss of melanin granules, increase in the density of residual bodies, accumulation of lipofuscin, accumulation of basal deposits on or within Bruch's membrane, formation of drusen (between the basal lamina of the RPE and the inner collagenous layer of Bruch's membrane), thickening of Bruch's membrane, microvilli atrophy and disorganization of the basal infoldings. Although these changes are well known, the basic mechanisms involved in them are frequently poorly understood. These age-related changes progress slowly and vary in severity in different individuals. These changes are also found in age-related macular degeneration (AMD), a late onset disease that severely impacts the RPE, but they are much more pronounced than during normal aging. However, the changes in AMD lead to severe loss of vision. Given the many supporting functions which the RPE serves for the retina, it is important to decipher the age-related changes in this epithelium in order to understand age-related changes in vision.

画像の平均輝度レベル，観視者の年齢，照明環境を考慮した液晶ディスプレイの輝度制御

We investigated what influences the average luminance level (ALL) of displayed images, screen illuminance, and viewers ages had on the preferred luminance of LCDs. Twenty young subjects (mean age: 21.8) and 24 seniors (mean age: 68.9) adjusted the luminance of a 17-inch 1000: 1 LCD monitor to their preferred levels under different experimental conditions. The results indicate that the preferred luminance of LCDs corresponded to the following formula: Lp=k×ALLα. This is where Lp is the peak white luminance of the LCDs, k is a constant, and ALL is the average luminance level of the displayed images. Here, α is a constant from −0.19 to −0.20 for the seniors and from −0.14 to −0.17 for the young subjects. The influences of age-related changes in vision and ambient lighting on the luminance requirements for LCDs are also discussed. These results can be applied to the design of luminance-control systems for LCDs.

Effects of Age and Illumination on Night Driving: A Road Test

This study investigated the effects of drivers' age and low light on speed, lane keeping, and visual recognition of typical roadway stimuli. Poor visibility, which is exacerbated by age-related changes in vision, is a leading contributor to fatal nighttime crashes. There is little evidence, however, concerning the extent to which drivers recognize and compensate for their visual limitations at night. Young, middle-aged, and elder participants drove on a closed road course in day and night conditions at a "comfortable" speed without speedometer information. During night tests, headlight intensity was varied over a range of 1.5 log units using neutral density filters. Average speed and recognition of road signs decreased significantly as functions of increased age and reduced illumination. Recognition of pedestrians at night was significantly enhanced by retroreflective markings of limb joints as compared with markings of the torso, and this benefit was greater for middle-aged and elder drivers. Lane keeping showed nonlinear effects of lighting, which interacted with task conditions and drivers' lateral bias, indicating that older drivers drove more cautiously in low light. Consistent with the hypothesis that drivers misjudge their visual abilities at night, participants of all age groups failed to compensate fully for diminished visual recognition abilities in low light, although older drivers behaved more cautiously than the younger groups. These findings highlight the importance of educating all road users about the limitations of night vision and provide new evidence that retroreflective markings of the limbs can be of great benefit to pedestrians' safety at night.

Creating Text for Older Audiences

Creating Text for Older Audiences

A Key to Aging in Place

Vision impairment is often overlooked by gerontological health professionals or attributed to normal age-related vision changes. With 26% of persons over the age of 75 reporting a vision impairment, it is time for vision rehabilitation professionals to be recognized and included in the multi-disciplinary service team. As the older adult population increases in numbers and longevity increases, it is expected that serious vision loss will become more prevalent. Recognizing the indicators of normal and pathological vision changes and the appropriate individual and environmental intervention strategies available are presented. A functional vision screening questionnaire is offered. Recognition of the unique and complimentary roles of each particular rehabilitation discipline can lead to more effective collaboration.

高齢者の視覚特性に適合した液晶ディスプレイの文字表示条件 表示輝度，コントラスト，文字サイズの主観的な適正値の若齢者との比較

We investigated the influence of age-related changes in vision on optimum display luminance, contrast, and character size of transmissive liquid crystal displays (LCDs). Young (28 persons with a mean age of 21.7 years) and old (28 persons, mean age of 68.1 years) subjects rated the subjective legibility and preference of 25 luminance and contrast combinations for five character sizes which were displayed on a TFT-LCD. The preferred angular character size for a display luminance of 80 cd/m2 was 33 minutes for old subjects and 32 minutes for young subjects. Display luminance requirements for subjective legibility in old subjects were twice as high as for young subjects. However, the actual display luminance preferred by old subjects was 130% of that by young subjects. These results indicate that old subjects must select a higher display luminance to maintain legibility. This may be due to an age-related reduction in visual contrast sensitivity in lower luminance conditions.

Implications of issues in typographical design for readability and reading satisfaction in an aging population.

The issues in typographical design that influence readability in an aging population are explored. The traditional response to age-related changes in vision has been "bigger is better," but we explore other major variables and vocabulary associated with page layout and design, including type classification and readability, justification, traditional rules of page composition, and issues of word forms versus character strategies. Other research areas that should be explored are also considered.

Psychophysics of Reading--x. Effects of Age-related Changes in Vision

This study examined the influence of age-related changes in vision on reading performance. Maximum reading speed was measured in groups of young (n = 16, mean age 21.6 years) and old (n = 14, mean age 68.3 years) subjects, all with acuities of 20/32 or better. A psychophysical procedure was used for measuring reading speed that has proven reliable and sensitive to visual factors in previous research. Data were collected for character sizes ranging from .15 degrees to 12 degrees. Research revealed that old subjects who were free of eye disease read as fast as the young subjects for character sizes ranging from .3 degrees to 1.0 degrees. This is the range in which reading speed is maximum for young subjects. Research also revealed that old subjects showed a deficit when reading text composed of very small or very large characters. Their speeds dropped to about 70% of the young adult speeds. These deficits may be due to age-related losses in visual contrast sensitivity.

Visual Changes among Older Workers: Implications for Workstation Design

Older workers consist of those who have experienced age related changes in vision or visual impairment. Age related visual changes may be compensated for largely through modifications of workstation lighting. Visual impairment requires much more extensive and individual redesign based on a careful task evaluation. The role of visual assessment is discussed.